The Electronic-cigarette Association of South Africa has labelled the government’s attempts to regulate the devices as a cop-out.
The association, made up of manufacturers and importers of e-cigarettes, wants to create its own rules. “We don’t want regulations that are just a copy-paste of cigarette legislation, because we are dealing with a completely different product,” says association chair Zuko Kubukeli. E-cigarettes – battery-operated devices that deliver nicotine in the form of a vapour – are not covered by the Tobacco Products Control Act, which regulates the sale, use and marketing of cigarettes, because e-cigarettes do not contain tobacco.
The Medicines and Related Substances Control Act regulates nicotine products that are used to help people stop smoking. Under this law, nicotine replacement products can only be sold by a pharmacy and may not be advertised.
But the National Council Against Smoking says e-cigarette manufacturers in South Africa “ingeniously market their product, not as a way to help people stop smoking, but as a hobby or pastime and therefore don’t fall under the Act” and remain unregulated.
“These things are being highly marketed when we don’t know the reality. We suspect they may be less harmful than cigarettes but we don’t know for sure,” says Yusuf Saloojee, from the council.
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Regulations for e-cigarettes
The health department is reviewing the tobacco Act with an eye to applying it to e-cigarettes.
The Food and Drug Administration (FDA) in the United States recently announced new regulations for the devices. According to the new laws, e-cigarettes containing nicotine must come with a warning and they cannot be sold to anyone younger than 18.
The FDA was concerned in the past that e-cigarettes could encourage adolescents to smoke, an issue that has also been raised in South Africa.
The number of American teenagers who use the devices increased to 16% in 2015 from 1.5% in 2011, according to the FDA. Between 2013 and 2014, 81% of young people who used e-cigarettes said it was because of the “appealing flavours”.
Although admitting that this could appeal to adolescents, Kubukeli says they are only a fraction of the users: “98.7% of the people buying e-cigarettes are people who are smokers, who want to reduce or stop smoking over time.”
A study released in April by the Royal College of Physicians in the United Kingdom recommends that e-cigarettes be used by smokers to reduce the harm caused by tobacco.
Harm reduction, according to the study, is used in medicine to minimise harm to individuals or wider society from hazardous behaviour. An example is the provision of clean needles to injecting drug users to avoid HIV infection.
The report estimates that the direct costs of smoking to the National Health Service is £2-billion a year.
“The total cost of smoking to society, including healthcare, social care, lost productivity, litter and fires, was conservatively estimated in 2015 to be around £14-billion per year.”
Although nicotine increases heart rate and blood pressure, it does not cause cancer. The report states that the main causes of death from smoking include lung cancer, resulting from “direct exposure of the lungs to carcinogens in tobacco smoke”, and “cardiovascular disease from the effects of smoke on vascular coagulation and blood vessel walls. None is caused primarily by nicotine.”
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Harm reduction provides “smokers with the nicotine to which they are addicted without the tobacco smoke that is responsible for almost all of the harm caused by smoking”.
Kubukeli says that, although nicotine is not entirely harmless, smokers and those around them can benefit from the use of e-cigarettes.
“This is so far the best way to improve your chances of complying with smoking cessation. They found that, when people use nicotine therapy like tablets and patches, or simply try to stop smoking by going cold turkey, they usually end up failing and [start] smoking again.”
According to the South African tobacco industry, 6.3-million adults smoke cigarettes, almost the same number as people who die worldwide every year because of tobacco, says the World Health Organisation (WHO). More than half a million of these deaths are the result of second-hand smoke.
“There are more than 4 000 chemicals in tobacco smoke, of which at least 250 are known to be harmful and more than 50 are known to cause cancer,” says the WHO.
Saloojee says there are already approved products to help people quit smoking.
“The evidence does not suggest that e-cigarettes are any better than these,” he says. “There are other [research] papers that say e-cigarettes do not help people stop smoking. The best studies I have seen say that e-cigarettes are no better than things like nicotine patches.”
Saloojee says it is irresponsible to promote a product that is not proven to be safe in the long term.
“The best thing people can do is to stop the use of all nicotine products, or only use these as a temporary measure to help you stop smoking.” Vape away to quit tobacco – or not.